Dr Graff on the Utilization of CAR T-Cell Therapy in R/R DLBCL

“For patients with DLBCL who relapse early within that first 12 months [following initial therapy], if they are a CAR T[–eligible] patient, they need to go to CAR T.”

Tara Graff, DO, a hematology/oncology specialist at MercyOne Mission Blood + Cancer, detailed the role of CAR T-cell therapy in the relapsed/refractory diffuse large B-cell lymphoma (DLBCL) treatment paradigm and when it may be appropriate to refer a patient.

Graff emphasized the central role of CAR T-cell therapy in the treatment of patients with relapsed diffuse large B-cell lymphoma (DLBCL), particularly those who experience early relapse within 12 months of first-line therapy treatment. While acknowledging the growing utility of bispecific antibody–based treatment in the second-line setting, she advocated that eligible patients in the second-line setting should be prioritized for CAR T-cell therapy, as this approach offers the most appropriate therapeutic intent at that stage of disease, noting that other therapeutic options will still be available in subsequent lines of therapy.

She explained that potential barriers to CAR T-cell therapy include both medical and non-medical factors, such as lack of referral to specialized centers, patient hesitancy, and variability in physician decision-making. Graff highlighted a key concern regarding the premature designation of patients as ineligible for CAR T-cell therapy, arguing that eligibility criteria are often applied too restrictively. In contrast to autologous stem cell transplantation, she suggested that a broader proportion of patients may be suitable candidates for CAR T-cell therapy.

Graff underscored the importance of involving CAR T-cell therapy specialists in eligibility assessments rather than making this determination in isolation. For patients not immediately considered candidates, she recommended a collaborative approach with CAR T-cell therapy centers, including the use of interim systemic therapy to assess disease biology and status, which may help identify patients who can subsequently proceed to CAR T-cell therapy and ensure more patients have access to this therapeutic modality.